What we need today especially in a country as diverse as India is to strengthen health system on a MISSION MODE with capacity to provide comprehensive healthcare for all. Urban and rural India is experiencing an epidemiological transition with the increase in lifestyle diseases like cardiovascular diseases, diabetes, hypertension, chronic respiratory diseases and cancer, particularly breast cancer and cervical cancer for women and oral cancer for men. Existing public health system falls short of providing access to quality healthcare services due to inadequate investment and sometimes the unintended consequences of reform that lead to weak infrastructure and low-quality services. Public health is closely associated with public interest and wellbeing, which is echoed as the common purpose of the central and state governments.
Health should be considered as one of the primary development agenda for every government. The Central Government may enact laws, but the implementation rests with the states. Collaboration between the center and the states on areas of common interest such as health should lead to inexpensive and sustainable health outcomes.
In India the burden of chronic non- communicable diseases (NCD) contributes to around 5.87 million deaths that account for 60 % of all deaths. Cardiovascular diseases (coronary heart disease, stroke, and hypertension) contribute to 45% of all NCD deaths followed by chronic respiratory disease (22 %), cancers (12 %) and diabetes (3%). The prevalence of tobacco use (smoking and smokeless forms), consumption of alcohol, obesity and overweight, raised blood glucose, blood pressure, lack of physical activity has been identified as some of the major risk factor attributable towards NCDs. We must shift the focus and necessitate systematic interventions on a massive scale to help reduce burden of these diseases on the public.
Interevention for NCDs need to leverage an effective delivery mechanism that is adaptive to the needs of the common people with a sufficiently strengthened health system. National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS) was initiated in 2010 through primary healthcare system i.e. 20,000 sub-centres (SCs) & 700 community health centres (CHCs) located in 100 districts across states. If implemented effectively, NPCDCS can reverse NCD scourge by focusing on (a) risk assessment, early diagnosis & appropriate disease management for persons with NCDs and those at high risk and b) health promotion and adopting healthy lifestyle for the general population. NPCDCS with its opportunistic screening at village (SCs), CHCs, district and tertiary hospitals, can reverse the debilitating NCDs effect through early detection and treatment. Additionally India’s move towards Universal Health Coverage is an important step to provide much needed financial protection to NCD struck people requiring expensive clinical-care, while enhancing abilities of primary health services to effectively prevent them at various levels.
The well researched National Blueprint –SANKALP, rightly urges Central and state governments to coordinate better in adopting latest technologies to deploy and manage a countrywide Health Information System (HIS). This will enable government authorities to monitor different population and health aspects including information on food, tobacco use, alcohol consumption patterns, availability of drugs & medical equipments, financial accounting and availability of human resources including specialists. Accurate data availability is critical to identify emerging gaps in provision of health/wellness services and taking informed measures to improve preventive and curative services. To be effective, pan India integrated states-wise HIS needs to have:
• Epidemiological surveillance identifying chronic diseases, associated risk factors by using data analytics.
• Healthcare services-performance report: Investigation, patient follow-up records, health-centre operations.
• Administrative record report: Financial accounting, drug stock management, personnel management and asset management.
A healthy population will help reduce burden on public welfare. Changing lifestyles of people, both in rural and urban areas with greater co-ordination and meaningful partnerships, there will be growing confidence that India can and will win with an effective state-wise response. However, though challenges are huge to prevent and control NCDs, the efforts will help transform the overall well being of the nation.
Article Source: www.health.economictimes.indiatimes.com
Dr. Damodar Bachani
Director Professor, Department of Community Medicine,
Lady Hardinge Medical College & Associated Hospitals